Thursday, May 31, 2007

Kevin Garnett doesn't ask for a trade and he gets criticized for staying with a poorly run team with minimal NBA talent and no plan for improvement.

Kobe Bryant does ask for a trade and he gets criticized for wanting to leave a poorly run team with minimal NBA talent and no plan for improvement.

Kobe needs to realize that no matter what he says or does, he will be resoundly criticized and vilified. If he contributes a million dollars to a charity while donating a kidney to an orphan-he's just trying to rebuild his image while decreasing the time he spends pissing. So Kobe, if you're reading this:

Get a life- my family won't read this. Read a book or something. And stick to your trade demands. Michael Jordan couldn't win with Kwame Brown on his team.

Note- Lakers team owner Jerry Buss was arrested for DUI. No one protested or called their local talk show host, despite the fact that 17491 people died in alcohol related accidents in 2006.

29 points in the 4th quarter and 2 overtimes (out of his teams' 30 points)??!?!?!?!?!?!

Wow. A few quick thoughts

1. How bad are the rest of the Cavaliers?2. Could someone wake up the Pistons "coaching" staff? Let them know you can double team the one guy who makes shots before he gets the ball. Let the corpse like players shoot.3. And let them know that you can make him work on defense.4. How in the Sam Hill do you let anyone dunk 3 times late in the game in the playoffs? The bad Boys Pistons would have knocked LeBron back to Cleveland. Knock him down! Maybe after he dunked on thin air twice, switch out of the zone defense. Or get Weber and his bad knee out of the way and put 'Sheed on him.5.Did they tell the Pistons fans not to cheer for most of the game?

So fees to become a US citizen are going up. Pro-Immigration advocates are upset that the fees are increasing dramatically (from $395-$1010). They are not upset that federal authorities are trying to improve service for applicants and reduce wait times for application processing. They are against paying more for better service. Apparently, the fact that it takes money and paid workers to process these forms is not important to them. At least not as important as complaining.

One other note- none of the articles I read about this topic noted when the last fee increase was enacted. If it's been 10 years, a fee increase is needed just to cover inflation.

Tuesday, May 29, 2007

Remember when people thought the Pistons were smart to get Darko Milicic instead of Dwayne Wade, Chris Bosh, or Carmelo Anthony because they won a title in 2004?

Can you imagine how good the Pistons would be if they had Bosh- he'd be the perfect fit. Good post-up game. Can shoot the mid-range jumper. High energy guy. Most people focus on 'Melo and Wade, but Bosh would have been worth one more ring (in 2005- when Detroit lost to the Spurs in 7 games in the NBA Finals) by matching up against Tim Duncan. Meanwhile the Heat "settled" for Wade- who is probably in Charles Barkley's 5.

So please remember that someone who is not Greg Oden or Kevin Durant in this next rookie class will lead his team to a title- possibly before Oden or Durant does.

Question: How many Americans died in alcohol related motor vehicle accidents in 2006?

I'm sure you heard more about Mad Cow Disease, West Nile Virus, the Bird Flu and teen athletes dying of heart disease than drunk driving. All of the above sells more newspapers. But what do you need to worry about more?

The Texas legislature just passed a bill authorizing steroid testing for high school athletes. Now, kids are on the juice, no question. And it's a bad public health problem. It's just that steroids= attention= votes. Drunk driving is so boring; no one wants to vote for the guy who's against drunk driving.

Friday, May 25, 2007

It looks like some medical experts are not too happy with the coverage of the Avandia/cardiovascular risk study. Apparently the limitations of the study stating that Avandia carries an increased risk of cardiovascular events were not noted. Also, the accompanying editorial was written by physicians who make a living saying that medication "x" is dangerous and the FDA needs to do a better job of oversight. Finally, there is concern that the New England Journal of Medicine should not have published the study at all, implying another lesser known journal should have published it. The media coverage is also questioned. This doesn't make for good press in the local newspaper, but it helps me answer patients' questions.

One other point, patients (and the media) tend to believe the doctors who say that medicine "x" is bad for you and can harm you more than doctors who say a product is safe. Meanwhile, doctors are raked through the coals for being pawns of the pharmaceutical companies, while the ones who complain about the FDA and "Big Pharma" make a nice living and a nice name for themselves if they keep finding drugs to condemn. What happens to them if too many drugs are safe?

Houstonian Tom Kirkendall is the son of a physician and a well respected lawyer (yes, it can happen). He is also a sports nut like me. The 2 posts I linked to are about the NBA and my Texas Rangers ("We're Punctual!"). Watch me masterfully link the topics of why the NBA has only had 14 teams win a title and why the Rangers have won one playoff game. And why the NY Times article about a shortage of tall people has nothing to do with who wins championships.

Team titles are won by organizations. The Spurs, Yankees, and Patriots have all had good ownership who realize that team sports are not won by All-Star teams. You have to have a GM who understands team dynamics and salary caps, not just who has the best stats. You need a coaching staff who can integrate young talent with the accompanying lack of experience, veteran talent with the accompanying slower reflexes, and mix it with long term strategies to deal with long regular seasons and short term strategies for playoff series and game planning with adjustments at halftime and good creative play-calling for last second plays. You need scouting departments who can help you pick good talent in the draft, free agent market and in trades while supplying useful information to help win games. You need a good marketing department to keep fans coming to the games and buying apparel and paying everyone's salary.

My Rangers have consistently switched managers and players like they're a fantasy league team. The once great Latin American scouting department has been disbanded for financial reasons (note- this is an unsubstantiated rumor). We paid A-Rod $&) million more than the Mets offered, and we still pay him $10-12 million a year to play for the team I hate from New York.

So LeBron James and Tracy McGrady will be relegated to making cool commercials and never winning a title as long as management keeps letting the Carlos Boozers go to Utah and interviews head coaches before the head coach is fired. The Detroit Lions can draft Jesus himself and sign the Heavenly Hosts to a long term deal and still go 3-13 as long as Matt Millen and the Ford family are in charge. The supply of tall people has nothing to do with the NBA's lack of Championship teams. Rangers' owner Tom Hick's poor management is the reason my team is so bad the announcers complain ON AIR about having to watch this team play the Devil Rays. It's the lack of a Championship level ORGANIZATION.

I am thankful today that I am not as talented as LeBron James. The man can't win for losing. First, he makes a difficult pass to a wide open Donyell Marshall (who looks a lot like Ludacris http://sports.espn.go.com/nba/players/profile?statsId=2627). It turns out it's LeBron's fault that Donyell missed the shot.

The next game LeBron has the nerve to miss the game winning shot. He followed that up by not complaining enough about getting fouled on the play. Larry Hughes, who missed the follow up shot, is not at fault. Everyone complains that Jordan would not have let his team lose

To sum up:1. LeBron should've shot the ball in Game 1.2. He should've passed or made the shot in game 2.3. He should complain like a spoiled baby.4. Jordan is God.

The same media guys complain about guys like Kobe who don't pass, bad officiating, and whiny prima donnas. They also forget that Jordan was a me-first, no title having Nike salesman his first 7 seasons. Can they pass a law making writers research their toic before spewing nonsense about people's character and will to win?

Thursday, May 24, 2007

I had to put a random question when I started this blog. The question was, "What is your favorite cheese?"

Mine used to be mozzarella. Then I was at Target and they had samples of this cheese that was $14.00 a pound. I thought to myself, "Self, one bite is worth a dollar- what a bargain!!" But the cheese was so good, I bought half a pound (for those of you that know me, you KNEW I wasn't buying a whole pound). I forgot the name of it, it's some Italian cheese. But I'm going to write it down and buy some for my next birthday or when my kids get married.

Well, Avandia is the latest medication to have a major advisory after being in the market for a number of years. No one is calling for it to be withdrawn from the market (yet), but patients are being asked to "call your doctor".

Given that I learned about this from the New York Times, I think I only know what the patients know. I have gotten an e-mail from Medscape (a service owned by WebMD, registration required) about Avandia, but I got it one day after the story broke in the print media. I used to take the New England Journal of Medicine, but for major stories like this one, the press release comes out 2 days before the journal gets to my mailbox. Given that most doctors use a computer as often as Paris Hilton says "no", it is rather difficult to get important messages out to physicians.

So go ahead and call your doctor, but please provide us with the reference article, because we probably have not read it yet.

Wednesday, May 23, 2007

I was at the dentist office with my kids and I was thinking, "These are neat people. I like them." Even after my son screamed like a drunken banshee during his exam. And he pooped.

You love them and protect them from day 1. But they just do so much cute, funny stuff (note, the screaming and pooping did not qualify as cute or funny). I like how they want a hug after you tuck them in at night. Adam (age 2) calls a hug "hut". Larissa (age 5) likes to rub noses together.

Tuesday, May 22, 2007

Pharmacy technicians receive an inordinate amount of abuse from patients and doctors. I've seen them get cussed out and blamed for making co-pays too high for the elderly, poor, young, and upper middle class. Most grocery store and big chain pharmacies are unimaginably busy. And no one says thank you to the pharmacy tech. So I usually take their side when patients complain about their pharmacy.

But this is not a rant if I do not complain. I'm tired of calling or faxing a prescription to a pharmacy, only to have the pharmacy technician say that it was not called/faxed. The patient usually calls our office complaining, we call the pharmacy....It just takes up extra time. And the pharmacy tech has to check the phone/fax line anyway. It turns into a sloppy he said/she said that leaves patients having less faith in both aspects of the health care system.

Of course, most of us docs don't get around to taking care of all daily correspondence (faxes, refill requests, referrals, etc.) every day. Can't blame the pharmacy for extra calls when we don't do our jobs.

Two interesting observations. Between pages 3 and 4, I was asked to participate in a reader survey. Likely to get marketing information for a third party. Also, I read an article about culinary school graduates and their mounting debt. The next day, i got 2 e-mails about enrolling in cooking school.

Anyway, if you have elderly family, call them often so they are less likely to fall prey to scam artists who act like their friends.

Thursday, May 17, 2007

I've seen 2 news stories today about food safety. Both focused on the E. Coli 0:157 outbreak in spinach last year. In fact, CNN just ran an ad for a one hour dangerous food investigative report. I wonder if CNN would have been mad if the investigation would have shown that food safety has improved.

Anyway, the point of both reports is that the government and the food industry need to do SOMETHING to make food safer, dang it! Which brings up my question- what do we do?

One report showed that a spinach farm with a good barrier system to keep out bacteria harboring animals can get contaminated if a bird lands in a cow pasture, gets some cow manure on its beak, and poops in the spinach farm that is 10 miles away from the offending cow. Pesticides might be able to reduce the rate of microbial contamination, but then the food does not qualify as "organic". And no one want to pay for irradiated food (and no one knows if that can cause health issues). And according to one expert- the FDA inspects each large food processing plant every 10 years. If they just had more funding and manpower (which means your taxes get raised) they can check every 5 years. Or the government can shift funding from some useless pork like education to pay for this upgrade.

Just once I would like a media outlet to say, we don't have an answer, at this time it is an unsolvable problem.

Monday, May 14, 2007

As the clock struck midnight I was at work on my night job. I admit patients from 6 pm to 6 am for a hospitalist group in Houston. I had just finished the 8th admit. So from midnight to 2 pm I was helping out a resident, entering patient information into the computer for patient care purposes, and entering patient care information for billing purposes.

From 2 am to 6 am I attempted to sleep, Every 20- 30 minutes I get paged, so I can't say I got good rest. I got enough rest to be able to be mildly coherent by 6:15. I saw 2 of the 4 patients I had been assigned from the Emergency Room and left the hospital by 7:30 am. Normally I see all of my admits, but May 12 is.....

My daughter's BIRTHDAY!!!!!! My Larissa is 5. She makes sure to remind us of this fact every 12-15 minutes. And she was having a big party at Bounce U- a place where kids bounce around on inflatable objects while their parents make sure kids stay on the inflatable objects while the parents discuss how we will pay for college when our 5 year olds are 18. Before getting ready, I watch SportsCenter with my son to see who won the Jazz/Warriors game when the see Baron Davis THROW DOWN on Andrei Kirilenko. I think the poster is available in Oakland as we speak. My son voiced his pleasure at seeing such an awesome sight. So then, a quick eat and shower leads to.....

10 o'clock- go pick up the cake from the Cake Lady in Friendswood (note- the best cakes as far as decoration and taste in the Houston Area. I'm getting hungry right now). I take my 2 year old son with me, because my wife is taking the now 5 year old to get her hair and nails done for the bounce party. So Adam Jacob "The Touchdown Maker" (TTM) and I go to pick up the cake, load up on a few groceries, vote in a bond election, get a nice bottle of wine (or 3) for Mother's Day, drop off a Mother's Day card for Granny (my mother-in law, who was working a 742,007 hour shift because she is a florist), and get lunch at McDonald's. All of this while I arrange a hospitalization after getting a call from the lab regarding a patient I saw in the office who had anemia so severe, she needed a transfusion.

Whew.

Back at home my wife and I get TTM and the birthday girl (TBG) down for a nap as we continue to prepare for the party. Of course, TBG is too excited to nap, so she helps clean out the car. I also pass out for an hour or so.

Just before leaving we go across the street to see my neighbor so they can wish TBG a happy birthday. I catch a couple of holes of the TPC Golf Tournament to keep the fan in me happy.

Now it's 4:15 and we arrive at Bounce U with a load of balloons, gift bags for party favors, a cake, and 2 kids. Back when I was a kid, we didn't have all of this pomp and circumstance. We had dirt, rocks, and hard times. Oh, wait- I'm channeling my parents- we had the same crap, I'm just a complainer. Soon, nine 5 year olds arrive with their posses (parents and siblings) and the bounce-a-thon is on. There are no casualties, although TTM may get food poisoning from eating off of everyone's plates (and the floor for good measure).

We leave the party with some leftover pizza, gifts that take a lot more space than the gift bags, and 4 kids. We're keeping my 2 nephews (aged 7 and 2) for my brother-in-law and his wife so they can celebrate their anniversary. So at home my attention is divided between gift opening, the 4 kids, and the Spurs/Suns game. We may have lost a kid or 2, but the game was FANTASTIC. I love playoff basketball. And my family, yes my family. The best part was when Manu Ginobili got hit in the eye, grew a black eye in, like, 15 seconds, and responded by scoring the next 8 points of the game. oh, and the look of joy from my daughter. which may have been sleepiness because she never took a nap while consuming cake and lemonade while playing like a screaming Banshee for 6 hours. Fortunately for the Spurs, the Suns cried about the officiating before the game and got absolutely no love from the refs.

Of course, I missed the end of the game to help give 4 kids a bath and help brush 100 or so teeth and get 3 people to bed. My 2 year old nephew refused to go down easy. So I went back to the hospital to see the patient with the anemia. I met the spouse and we talked for about 15 minutes. It's a little weird to meet someone one day and tell them the need an urgent transfusion the next day. Especially when the person does not have an obvious source.

Finally, I get home, take a shower, and find another male in bed with my wife (my nephew). I respond by getting in bed with them. I spend about 10 minutes in bed when I notice my nephew curled under me, snoring like a freight train, and kicking me like a young Pele. I call this the "baby Hat Trick". In honor of this achievement, I go to the couch so I can sleep.

Roger Clemens is going back to New York. People here in the Houston area are acting like he's taking the petrochemical industry with him. And to think he has the nerve to take the job with more money?!?!?

Oh, wait- I know how to count, too. I'd move for more money (which I did in 2001 at the end of residency). Yes, I took a higher paying doctor job over a lower paying one. Apparently, no one who listens to sports talk radio would do that because they love their employer or hometown too much to take more money for the same job elsewhere.

Friday, May 4, 2007

A man came in today with valid insurance. He had called 3 or 4 other doctors' offices for appointments. Although other offices accepted his insurance, he was told they were not taking new patients with his plan.

When he called our office we "gave" him an appointment. It took us 20 minutes to figure out how to bill his insurance plan (we 'll find out in 90 days). The main reason we gave him an appointment is that he was wheezing really loudly on the phone and he said his blood pressure was high. This seemed urgent.

When he got here we noticed he had trouble breathing, so we started treating him before we got all of the paperwork done. We have a policy here that if someone isn't breathing well, we should do some doctory-like stuff. He was very happy with our service. I simply saw a sick person who had valid insurance.

This has been happening about once or twice a week for the 3 months I have been open. Sick people can't get appointments to see a primary care doctor- even when they have a primary care doctor, on the day they are sick.

Maybe I'll look at this differently when (if) I've been in business long enough to have a full schedule and employees that were not in my wedding as the bride. But isn't it weird that sick people can't find a doctor, even when they can pay the bill?

I was going to write a real entry, but did you see the Warriors/Mavs game last night?!?!?!? Those fans were amazing. I'm not a big fan of the color yellow, but seeing that sea of yellow, yelling, cheering, chanting.....that was cool.

We should have seen this coming. The Warriors made a big trade mid season to get Stephen Jacksona and Al Harrington for the slow Mike Dunleavy, Jr.. Baron Davis has been healthy for the first time since he nearly beat the Magic by himself in 2001. And the Warriors wer 3-0 against Dallas this year.

Anyone seen Dirk's game? Oh, Stephen Jackson took it and is taking it with him to Utah or Houston next week.

(note- GSW usually stands for gun shot wound in medical parlance. Every time I see it on the sports ticker, I kind of jump before I realize it's the Golden State Warriors. Then I remember they play in Oakland and I worry again.)

I have my own ethical dilemma. I'm a primary care doctor. I take care of everything from colds to diabetes. I especially like diabetes, high blood pressure, asthma, and prevention. Every month, guidelines are updated for these and other conditions. New medications, new tests, better health outcomes. There are continuing education classes in great cities to stay up to date. I can even learn online.

And I am getting ready to sign up for a cosmetic procedures class.

If I see a patient for something important, like high cholesterol, I have a 90% chance of getting $40-$120 from their insurance plans. If I perform a Botox treatment or take care of varicose veins, I will get $250-$500 from the patient. Before I sound like a greedy bastard, remember- I'll need to see 8-14 daily (with a staff of me and my wife) to break even doing primary care alone. I would like to stay in business long enough to hire staff and pay them (and Uncle Sam).